T is for Talus, Part I


It was a crisp, chilly, and crystal clear morning in Mill Valley. The sound of the creek and the aroma of the damp redwood forest floor across the street greeted me as I laced up my shoes and skipped down the steps to Miller Avenue. It was high October. I was meeting some friends at the Depot for a run. It couldn’t have been a more perfect morning. I was getting married that afternoon.

Before setting out for 12 miles in the headlands, I remember telling my friends I was feeling a dull pain in my left heel. Nothing major, just a little odd and sudden. I had logged some decent miles that fall and raced a handful of cross country races, the magnitude of which paled in comparison to Boston marathon training I had done that spring. I thought little of the pain at first. 18 years of competitive running under my belt, managing lower extremity niggles is just part of the sport.

Old Mill Park, Mill Valley

A few weeks earlier I had paid a visit to my podiatrist with pain up the shin on the same leg. I felt content with his diagnosis of “posterior tibial tendonitis”. Anything but a stress fracture, I thought, and did not press for an MRI. With the season winding down to a taper and my fitness in top form for the remaining few championship races on the calendar, it was easier to assume the best.

Later that week, I had an encouraging workout (1600m 4:50, 15 min @ 5:30/mile pace, 1600m 5:00. 90 sec recovery between each). A few twinges in the ankle in the last mile – it crossed my mind whether I should stop mid-interval – but the momentum was strong and I finished the workout. Another week and the pain started hampering easy runs and my optimism. I got in the pool for aerobic work and tried to maximize the remaining few workouts I had left. One day at a time. I continued to choose to believe the doctor’s diagnosis over the increasing pain.

That weekend was the USATF 5K National Road Championships in NYC. A heel insert, over the counter arch support, KT tape, sheer tyranny of will … I doubled down. With tunnel vision, I did everything I could to finish the season. For what? External validation, proof of fitness, a PR? Hindsight would later show me my insolence.

Central Park, US Road 5K Champs, 2017 (two weeks into initial ankle pain)

Racing is an exercise in enduring as much discomfort that can be tolerated before physiology gives way to mental resolve. According to Tim Noakes’ “central governor” theory, it’s the brain – not necessarily physiology – that regulates our physical limits. Thus, part of training of a distance runner is about developing a measured level of agnosticism to pain. Runners are constantly discerning between what kind of pain and how much can I tolerate. The hazard of getting good at managing pain is that it becomes difficult to differentiate between the two types: what can be ignored and what cannot.

But the brain has a finite capacity to deal with discomfort. I learned this the hard way: through experience.

I learned that my natural limit of double-dipping into the two types of pain at the same time is around 16:30 for 5K. It turns out that managing the nagging pain in my ankle drained the mental store reserved to deal with the self-induced pain of finding the extra gear. The race was a disaster. Pain deep in the ankle with every stride. Cool down impossible. Walking was a challenge. Ice bucket, massage at the race headquarter hotel. No PR to show for it.

Post race, USATF 5K National Road Champs, 2017

Two more haphazard weeks of painful on and off running; two more sub-par race performances. I finally gave in to the absurdity of my denial and followed the encouragement of a teammate to get an MRI. I sat and listened as the podiatrist read my prognosis like it was prison sentence for crimes I had committed.

Non-displaced talar stress fracture in the lateral portion of the posterior process. 4 weeks in a full-length orthopedic boot, then reassess.

The verdict did not shock me. In fact, my disappointment was overshadowed by relief. I did not have to keep fighting anymore. And in my twisted naiveté, I felt no regret. Like any other stress fracture, I assumed this one had a known timeline. 6 to 8 weeks, 12 max, of non-weight bearing activity. I would hit the cross training hard for a time and maybe even salvage a late track season. The podiatrist strapped me in the boot and offered me crutches. I thanked him, politely declined and went on my way.

Silicon Valley Turkey Trot, 2017. (5 weeks after initial pain)

Pain is weird. Days before I was making bargains with my brain over the degree of pain I could withstand to grit through a 5K. Now with an undeniable reason behind the pain, I found that I could not walk out of the hospital under my own power. I turned back and asked if I could have the crutches.

To be continued…

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